Fig. 1 |. Mechanisms of COVID-associated hyperglycaemia and ketoacidosis.

The findings of hyperglycaemia and ketoacidosis in patients with COVID-19 have prompted the question of whether there is underlying diabetes, regardless of whether it was previously recognized. Ketoacidosis can occur independently of hyperglycaemia even in patients who are not being treated with sodium/glucose cotransporter Sglt2 inhibitors. The mechanisms of these metabolic abnormalities involve impaired glucose utilization as well as decreased insulin secretion or increased counter-regulation. Examples of salient pathophysiologic features at the intersection of diabetes, acute intercurrent illness of any kind and COVID-19-specific factors are shown next to each target organ. Depending on the clinical course, these abnormalities may unfold in a rolling fashion rather than all at once.